I would like to start the new year off by taking a serious look at a very serious and difficult subject – suicide. I recently attended a wonderful workshop on suicide intervention, one that made me realize how profound the problem is. At the same time, there is hope – through education and removal of stigma, identification of risk factors, and development of suicide intervention skills.
Although most of us have just enjoyed a period of celebration and goodwill, Christmas is a high-risk time for suicides, with December, January and February the worst months. In Alberta, suicide is among the top ten causes of death. Of even greater concern is the high rate of suicidal behaviour. Statistics for 1999 for Alberta, which has a population of 2,959,504, indicated 447 reported suicides: 15.3 per 100,000 people. Another 45 unreported suicides were documented – cases where suicide is suspect but the coroner cannot label it suicide without an extensive post-assessment. In that same year, however, a staggering 44,700 people engaged in non-fatal suicidal behaviours. In other words, for every person who successfully completed suicide, another 100 people attempted to injure themselves and did not succeed! (SIEC, 2002; ACICR, 2001).
Across Canada, statistics are equally frightening. Suicide is the fifth leading cause of death among Canadians, exceeded only by cancer, heart disease, cardiovascular disease, and unintentional injury. Some aboriginal communities have suicide rates 3-5 times higher than the rest of Canada. According to Statistics Canada, in 1999 the Northwest Territories led the way, with 40.5 suicide deaths per 100,000. Yukon followed with 21.3; then Quebec at 19.8, with Alberta fourth at 15.3, and Saskatchewan fifth at 12.7. All the other provinces were within the 10-12 per 100,000 range with the exception of Ontario with 9.0, and Newfoundland with 7.0. If we operate on the assumption that non-fatal suicidal behaviours follow a similar pattern across Canada, this would make suicide and suicidal behaviour the most prevalent “?ailment’ in Canada! Research shows that 1 in 25 Canadians will make a suicide attempt at some point during their lifetime, and 1 in 10 will seriously consider it (ACICR, 2001).
Yet funding, research and health care focus on cancer, heart disease, respiratory disease and other “diseases.” Suicide is ignored because of the stigma attached; it is a taboo subject, hidden, a shameful secret we mention only in hushed whispers. Many people, particularly those of certain religious backgrounds, consider suicide attempted murder, a crime, something that is a person’s own choice and thus undeserving of preventative research funding or sympathy. Many religions even forbid conducting memorial services or allowing burial for victims of suicide. Some feel that suicide is selfishness, and discount it as attention-seeking behaviour.
Is suicide simply a matter of personal choice? Is it just a selfish cry for attention? What drives a person to such an act of desperation? Removing the stigma and seeking to understand what causes suicide is an important first step toward trying to find a solution to the problem.
Anyone who has studied human development is familiar with Maslow’s heirarchy of needs. Maslow proposed that we all have basic needs, beginning with physiological, then moving into safety, love and self-esteem. If these needs are met we remain healthy and grow towards self-actualization. If they are not met, we become sick. An individual may appear to have all the physiological necessities of life, yet their needs for safety, love and self-esteem are not being met. A person who has lost the means to fulfill any of these needs becomes at risk for suicide; a person who has suffered considerable loss is at very high risk. It is important to recognize that actual loss does not have to occur – it is whether a person perceives it this way that matters.
Loss of safety, for example, could occur with a child who is abused by a parent and has lost the security of a safe home environment; or a woman whose sense of safety has been violated through rape. Love and a sense of belonging is next in the hierarchy. We all need to be loved, to feel needed and appreciated as part of a group, such as family or social group. A person who has lost a loved one, or who has lost family or membership in a group they care about, is not meeting their need for love and acceptance. Self esteem has two elements: that which comes from a sense of personal accomplishment, and that which depends on the attention and recognition of others. For example, a person who is fired from a job, or who has gone through a difficult divorce, may feel inadequate or less than capable, and therefore lose self-esteem.
All of these losses come in the form of stressors on a person. Many of us experience these stressors and are able to cope. Some cannot, and suicide becomes an option. What determines whether a person will have necessary coping skills? Why do some people become so desperate that they see death as the only viable alternative? The main determinate is: resources.
There are two levels of resources; internal and external. Internal resources are those within a person: their sense of self-esteem, personal abilities and skills, creativity, intelligence, faith, etc. External resources are things like family, friends, job, religious organization affiliation, community resources, finances, etc.
Stress and multiple loss deplete these resources. A person who has lost all of their internal resources no longer has control over their own life. They are hopeless and helpless, and they perceive themselves to be completely alone, particularly if external resources are lost as well. The pain becomes unbearable, and death seems like the only option, one that will stop the pain and make things better for everyone involved. There are some common characteristics of suicide:
1. A common stimulus for suicide is unendurable psychological pain. People are in intolerable pain, and suicide is seen as the only way to stop the pain.
2. The common stressor is frustrated psychological needs. Basic needs are not being met (physiological needs, or the need for safety, love, self-esteem).
3. The common purpose of suicide is to seek a solution. For a person in pain, suicide seems to be the only possible answer to a hopeless situation.
4. The common emotions of suicide are hopelessness and helplessness.
5. Ambivalence is a common internal attitude. Although in intolerable psychological pain, feeling hopeless and helpless, with no possible answer except death – the person still yearns for rescue.
6. The common cognitive state is tunnel vision. No other options are apparent. A person may even believe that they are doing others a favour by removing themselves – an act of love.
What then, should we conclude about suicide?
1. A person who considers suicide a solution has reached a point of unendurable psychological pain, and loss and stressors have led to an overwhelming sense of hopelessness and helplessness.
Suicide is not just “personal choice” – it is seen as the only possible solution for a hopeless situation.
2. Internal and external resources have been completely depleted due to stress and loss, and the person feels completely alone.
Suicide is not a “selfish act,” it is the only way to stop the pain for a person who truly believes they have no other resources.
3. The depletion of internal resources leads to tunnel vision, where the person has difficulty even accessing their own feelings of ambivalence about living versus dying.
Suicide is not just an attention-seeking “cry for help.” Rescue may be hoped for, but this is generally not on a conscious level. Many seek help from physicians or friends, but come to believe that no one in their life is listening.
Contrary to what many believe, suicide is not always caused by depression or mental illness. Depression, other mental illness, and substance abuse may be present, and these represent increased risk of suicide. Often, however, there are few external indicators of the severe internal pain and hopelessness that the person is feeling. Stressors may not be obvious, and even if they are, we do not always know whether the individual has the necessary coping skills. Sometimes the person considering suicide actually experiences a lift in mood because they believe they have now finally found a solution.
What, then, can be done to prevent suicide? Research in suicide prevention has discovered specific risk factors, and these can be used to assess level of risk for suicidal behaviour. Next week we will look at those risk factors, and the suicide crisis intervention model.
References & further information:
SIEC: Suicide Information and Education Centre. http://www.siec.ca/sptp/index.htm
Canadian Mental Health Association: http://www.cmha.ab.ca/
ACICR: Alberta Centre for Injury Control & Research (2001). Suicide in Alberta, Data Report, 1993-1997. Suicide Facts. http://www.med.ualberta.ca/acicr/
Statistics Canada: http://www.statscan.ca
Maslow’s Hierarchy of Needs: http://web.utk.edu/~gwynne/maslow.HTM
Schneidman, E (1985). Definition of Suicide. John Wiley & Sons. See:
World Health Organization. Suicide statistics worldwide.
Debbie is a native Edmontonian, and a single parent with four daughters. She has worked as a professional musician for most of her life, and has enjoyed a rich variety of life experiences – with many more to come! Debbie is working towards an eventual doctorate in psychology, and currently serves as the president of the Athabasca University Students Union.